Regarding this Dr. G.R. Ravindranath, General Secretary DASE has issued the following Press Statement.

Both houses of Parliament has passed a bill, regarding to fix the age of the retirement of the AIIMS Director at 65. DASE welcomes the bill, and urges the faculty members and doctors of AIIMS to withdraw their unnecessary protest against Dr. Anbumani Ramadoss, the Union Health Minister.

Medical, Legal, Medicolegal Information for Doctors and Lawyers: Medico-legal curriculum draft release today

MBBS Course Duration should not be increased from 5 ½ Years to 6 ½ Years!
Don’t Abolish more than 31,000 Permanent Job opportunities of Doctors in the name of Compulsory Rural Service!

The Central Health and Family Welfare Ministry has decided to implement Compulsory Rural Service for the MBBS candidates through out India. For that it has decided to increase the MBBS Course Duration from 5 ½ Years (4 ½ Years Studies + 1 Year Internship) to 6 ½ Years (4 ½ Years Studies + 1 Year Internship + 1 Year Compulsory Temporary Service). It has planned to pay Rs.8,000/- per month as stipend for the Compulsory Service.

If the scheme is implemented it will affect the job opportunities of young doctors. At present more that 31,000 doctors are coming out after completing their degrees from 262 Medical Colleges across the country. Within 10 Years the number will increase to 40,000. If the Government puts them all in Compulsory Service it will abolish the Permanent Job Opportunities of young doctors.

Eventhough the title of the scheme is mentioned as, Compulsory Rural Service, it is not so. During the One Year Compulsory Service the doctors will be posted for 4 months in District Head Quarters Hospitals, 4 Months in Taluk Head Quarters Hospitals which are situated in Urban Areas. They will be posted in Primary Health Centres for another 4 Months. Most of the period they will be working in Urban Hospitals. So, it is not a Rural Service, it is a Compulsory Service that’s all. So the aim of the service is to fill all vacancies at Government Hospitals by posting Young Doctors on Compulsory Temporary Rotatory basis. This Compulsory Service will abolish job opportunities and it will be against social justice.

For implementing the Compulsory Service increasing MBBS Course duration will cause the following adverse effects.

1. The Course duration will be made as a prolonged one.
2. It will be against social justice since SC/ST/OBC Candidates cannot go for long duration studies.
3. It will be against the interest of the poor and middle class students who receive education loans from banks.
4. It will be against the interest of the female candidates.
5. To become a full fledged specialized doctor it will take atleast 12 Years (5 ½ Years MBBS + 3 Years PG + 3 Years Super Speciality)
6. Because of the Break System prevailing in the MBBS Course Large number of students from Rural Areas who studied in Mother Tongue could not complete their courses within 5 Years. So, if the course duration is increased by another one year it will be a burden for the rural students.

Alternatives


1. More Medical Colleges should be started immediately in North, North-Eastern States. Orissa, Bihar and other states were medical colleges are not adequate.
2. During MBBS Admissions 25% seats should be given to the Rural Students after getting assurance that they will work in their area for a minimum period of 5 Years.
3. Doctors salary should be increased
4. More incentives should be given to doctors working in Rural Areas.
5. Special Quotas should be given in the PG Seats for Rural Doctors
6. 50% of PG Seats should be reserved for Government Doctors through out the country including in All India Quota Seats, AIIMS, JIPMER and Other Premier Institutes.
7. Special Rural Service marks should be added to the PG Entrance Exam Marks to the doctors working in rural areas.
8. Priority should be given in promotion to the doctors working in rural areas.
9. Proper housing, transport facilities and schooling facilities for the children of doctors working in rural areas to be provided.
10. During appointment local Rural Areas doctors should be given preference for that areas hospitals after getting assurance that they will work there for a minimum period of 5 Years.
11. PG Seats should be increased and it should be started in all Government Medical Colleges immediately.
12. In some places doctors are not attending the PHCs and Hospitals regularly. Peoples Monitoring Committee which includes elected peoples representatives, doctors and other hospital employees should be setup in every hospitals to rectify the irregularities.
13. Interest Free Special loans should be provided by the Nationalized Banks to the doctors starting Small Hospitals in Rural Areas.
14. Free Land, Electricity and other Concession should be given to the small hospitals in rural areas.
15. Cooperative Medical Care Facilities, hospitals should be started in Rural Areas.
16. Rural Area Hospitals’ Infrastructure and other facilities should be increased
17. More Fund should be allocated for health.
18. Short Duration Courses (3 Years) should be started if necessary to provide Primary Medical Care for Rural people wherever MBBS Graduates are not available.
19. If Compulsory Service is needed for the benefit of the people, Full Pay and all benefits of Government Doctors should given, and if the candidates like their services should be regularized. This rights should be given to the states. States can decide according to their needs.

Yours truly,

Dr. G.R. Ravindranath

General Secretary – DAS

22 Nov 2007, 0235 hrs IST,Hemali Chhapia, TNN

MUMBAI: The Maharashtra government, which once put off two top educational institutes from setting up campuses in the state by demanding quotas for locals, is now ready to clear a bill that would allow private players to set up universities without reserving any seats, including for backward category students.

Sources in the higher and technical education department said the Self-Financed Universities Bill (Establishment and Regulation) is expected to be tabled before the upper house in the ongoing winter session.

A year ago, it was passed by the assembly, but amid apprehensions in the council about zero reservations it was referred to a joint select committee. The latest draft of the bill, to be presented to the council, maintains the previous stand on no-reservations. The self-financed universities would set their own fees.

This is the same government that in 2002 dissuaded IIM-Ahmedabad from setting up a campus in Mumbai by demanding seats for locals.

There had been extensive parleys and paperwork, and a 25-acre plot had been reserved in Kharghar.
Earlier, when the Shiv Sena was in power, ex-McKinsey head Rajat Gupta wanted to set up the Indian School of Business here. Again, the government asked for 10% of seats for locals and the project went to Hyderabad.

Union Health Minister Plans 12-Month-Long Mandatory Rural Posting For Graduates

Prafulla Marpakwar I TNN

Mumbai: Medical teachers and students in the state have strongly opposed a move by Union health minister Anbumani Ramadoss to extend the five-and-a-half-year MBBS course by a year, with the last year as mandatory rural posting. They have said that the move will be counter-productive since fresh medical graduates will not be able to deliver the desired results.
"A fresh MBBS graduate is too inexperienced to handle crisis situations in a rural set-up, which will be unfair to the rural population,'' a senior professor said.
Ramadoss is considering extending the course following recommendations by the National Rural Health Mission. A month ago, he had set up a high-level committee headed by additional director general of health services R Samba Siva Rao to ascertain the views of under-graduate and post-graduate teachers, medical teachers, parents and associated groups before implementation of the rural posting for medical graduates.
Accordingly Rao, on Wednesday, held a marathon meeting with medical teachers and students from 42 medical colleges across the state, senior officials of the medical education department and the directorate of medical education and research at JJ Hospital. Rao explained the proposal and said, "Our rural health care system is weak and we want it to strengthen in a time-bound period. Hence Ramadoss, on the recommendation of the ru ral health mission, has mooted the new concept.''
However, medical teachers opposed the move and also raised the following objections.
Students who want to continue post-graduate studies will be affected as a gap of one year in a non-academic environment will have an adverse effect on their studies.
The course is already long and adding a year is unfair. Making it compulsory with a meagre pay or stipend amounts to exploitation.
It is likely that if this scheme is implemented, the number of posts in rural areas may be insufficient to accommodate all the graduates.
In its report, NHRM has said that public health centres across India are poorly managed owing to acute shortage of manpower. In Maharashtra, out of the 6,000 public health centres, there are no doctors at at least 1,600 centres, while at 2,000 centres, the medical officers are appointed on adhoc basis for 11 months. As a result, rural healthcare in the state is almost absent.
MBBS students currently have to undergo three months rural posting. A former dean said India is facing an acute shortage of doctors, owing to wrong policies and a casual approach. "Medical colleges increased from 80 in 1970, with 10,000 seats, to 240 in 2007, with 30,000 seats. Despite this we have been unable to provide adequate human resources.''
After ascertaining the views from all the states, Rao will submit his report to Ramadoss by December 2007.

DOCTOR THREATENS HUNGER STRIKE

In a fitting description of the falling state of medical education in the state, a surgeon who has served the government for over two decades, has threatened to go on a hunger strike from Thursday noon. An associate professor with the surgery department of state-run JJ Hospital, Dr S S Rajput says the government not only withheld his promotion and arrears for years, but is also refusing to grant him his VRS. A super-specialist in cardio-vascular thoracic surgery, he says his promotion to the post of professor has been denied and increments withheld since 1993. "To suffer injustice is as good as being unjust. So I've decided to take this extreme step,'' Dr Rajput told TOI. He has given a copy of his letter to JJ Hospital dean Pravin Shingare, police and Mantralaya officials. "We have forwarded the letter to the government and will look into the matter,'' said Dr Shingare. TNN

From http://epaper.timesofindia.com/Daily/skins/TOI/navigator.asp?Daily=TOIM&login=default&AW=1195743850171

Undergraduate students from five medical colleges in the Capital held a protest march on Friday against Union Health Minister Anbumani Ramadoss' decision to add one year compulsory rural service to the MBBS (Bachelor of Medicine and Bachelor of Surgery) programme.

MBBS students from the All India Institute of Medical Sciences (AIIMS). Maulana Azad Medical College (MAMC), Lady Hardinge Medical College, Vardhman Mahavir Medical College (VMMC) and University College of Medical Sciences carried out the five-kilometer march from MAMC to Jantar Mantar, showing their support for fellow medical students in Tamil Nadu who have been protesting against the decision for the last two and a half months.

"We do not mind going to rural areas and offering services, however, it should not be a part of the degree. It does not make sense; the government should send senior doctors instead of students.The degree is already the lengthiest of all undergraduate degrees, with another year added, the government is only trying to cut down on its public health expenditure by mandating free services from us," said Harkirat, President of AIIMS Students Union.

According to medical students the Central government spends a mere 0.9 per cent of the gross domestic product (GDP) on health expenditure against the World Health Organisation recommended 5 per cent.

From http://in.news.yahoo.com/071123/32/6nmm5.html

“Do not make service in rural areas compulsory”

Says Tamil Nadu Government Doctors Association

MADURAI: Increasing the duration of the M.B.B.S. course and introducing compulsory rural service in the pretext of improving rural health service is a gross exploitation of medical graduates, said K. Senthil, Secretary, Tamil Nadu Government Doctors Association (TNGDA).

Supporting the agitating medical students and house surgeons in their cause, he said that introduction of the new system would be a retrograde step that would discourage cream of talents from pursuing medical education.

Poor remuneration

Citing poor remuneration in the field as one of the reasons which restrained students from taking up medical education, he said that the situation would worsen if the duration of the course was increased for compulsory rural service.

The TNGDA with its members working in rural areas had felt that such a move was uncalled for and had suggested certain motivational measures to promote rural service, he said.

Additional Marks

The Tamil Nadu Government had been granting one additional mark for one year of rural service to a maximum of 10 marks in the Tamil Nadu Post Graduate Entrance Examination, said Dr. Senthil and wanted the same to be followed in the All India Post Graduate Entrance Examination.

“The Government had conceded favourably to our request to grant two marks per year for those working in hilly terrains,” he said.

Extra remuneration could be paid to the medical professionals for working in remote and interior places, he suggested.

If at all Government wanted to make rural service compulsory citing the pitiable state of affairs in States like Bihar, Uttar Pradesh or in North Eastern States, State Governments could direct the respective State Medical Councils to register all medical graduates for a period of 10 years with one year compulsory rural service.

Registrations could be renewed on fulfilment of the condition, though TNGDA was not for compulsory rural posting, he said.

“Unwanted” step

The TNGDA also appealed to the Tamil Nadu Chief Minister to intervene and stop the “unwanted” step by the Union Health Ministry.

From http://www.hinduonnet.com/2007/11/18/stories/2007111858570200.htm

அரசு மருத்துவமனைகளையே தனியாருக்கு வழங்க திட்டம் வகுத்துள்ளவர்கள்
சேவையைப் பற்றி பேசுவது கேலிகூத்தாகும். கட்டாய சேவை என்ற பெயரில் மருத்துவர்களின் நிரந்தர வேலை வாய்ப்பை பறிக்கும் மத்திய மக்கள் நல்வாழ்வுத் துறை

அரசு மருத்துவமனைகளில் நோயாளிகளிடம் கட்டாய கட்டணம் வசூல் செய்வதை ரத்து செய்ய தயாரா? சமூக நீதிக்கு குரல் கொடுப்பவர்கள் எம்.பி.பி.எஸ் படிப்பு காலத்தை உயர்த்தி சமூக நீதிக்கு சவக்குழி வெட்டலாமா? பாட்டாளி மக்கள் கட்சி தெளிவுப்படுத்த வேண்டும்.

இது குறித்து இவ்வமைப்பின் பொதுச் செயலாளர் டாக்டர் ஜி.ஆர். இரவீந்திரநாத் விடுத்துள்ள பத்திரிகை செய்தி.

பட்டாளி மக்கள் கட்சி சார்பில் அக்கட்சியின் தர்மபுரி தொகுதி மக்களவை உறுப்பினர் டாக்டர் ஆர். செந்தில் அறிக்கை வெளியிட்டுள்ளார். அதில் உண்மைக்கு மாறான செய்திகளை வெளியிட்டு மக்களையும்இ மருத்துவ மாணவர்களையும் குழப்ப பார்க்கிறார். இது கண்டிக்கத்தக்கது.

கட்டாய சேவை என்பது ஒன்றும் புதிதல்ல என்று கூறி மத்திய அரசு கொண்டு வரும் கட்டாய சேவை திட்டத்தை தவறான முறையில் நியாயப்படுத்த முயலுகிறார். மருத்துவர்கள் முதுநிலை படிப்புக்கு முன்பும் - பின்பும் கட்டாயம் அரசு மருத்துவமனைகளில் பணி புரிய வேண்டும் என்ற திட்டம் மகாராஷ்டிரம்இ கோவாஇ ஒரிசா போன்ற சில மாநிலங்களில் நடைமுறையில் உள்ளது. மக்கள் நலனை அடிப்படையாக கொண்டு இம்மாநில அரசுகள் அவ்வாறு செய்கின்றன. அகில இந்திய ஒதுக்கீட்டு இடங்களுக்கு முதுநிலை மருத்துவக் கல்வியில் 50 விழுக்காடு இடங்களை ஒவ்வொரு மாநிலமும் வழங்கும் நிலை தற்பொழுது உள்ளது. தனது மாநில முதுநிலை மருத்துவ இடங்களை பிற மாநிலத்தவர்கள் எடுத்துவிடாமல் தடுப்பதற்காகவும்இ தனது மாநில மக்களின் நலன்களுக்காகவும் அம்மாநில அரசுகள் இவ்வாறு கட்டாயச் சேவையை நடைமுறைப்படுத்துகின்றன. தமிழகத்தில் இவ்வாறு இல்லாததால் முதுநிலை மருத்துவக் கல்வி இடங்களை பிற மாநிலத்தவர்களிடம் நாம் இழந்து வருகிறோம்.



அகில இந்திய ஒதுக்கீட்டு முறையை ரத்து செய்யக் கோரி பல போராட்டங்கள் நடத்தியும் மத்திய அரசு எந்த நடவடிக்கையும் எடுக்கவில்லை. அகில இந்திய ஒதுக்கீட்டு இடங்களை ரத்து செய்து மகாராஷ்டிரா சட்டமன்றத்தில் சட்டம் கொண்டு வந்தும் உச்சநீதி மன்றம் அதை செல்லாது என்று கூறிவிட்;டது. இந்நிலையில் மாநில நலனைக் கருதி மகாராஷ்டிரம் முதுநிலை மருத்துவக் கல்வியில் கட்டாய சேவையை நடைமுறைப்படுத்தி உள்ளது. இதனால் படிப்பில் கால நீடிப்பு ஏற்படுவது இல்லை. எனவே இத்திட்டத்தை மத்திய அரசின் திட்டத்தோடு ஒப்பிட முடியாது.

டாக்டர் செந்தில் குறிப்பிட்டுள்ளது போல மருத்துவ மாணவர்களை கட்டாய சேவைக்கு அனுப்பும் திட்டம் இந்தியாவில் எந்த மாநிலத்திலும் நடைமுறையில் இல்லை. அவர் தவறான தகவலை வெளியிட்டுள்ளார்.

கேரளாஇ மகாராஷ்டிரா போன்ற மாநிலங்களில் எம்.பி.பி.எஸ் முடித்த டாக்டர்களுக்கு கட்டாய சேவை தற்பொழுது அறிமுகப்படுத்தப்பட்டுள்ளது. அதற்;கு காரணம் மாநில அரசுகள் அல்ல மத்திய மக்கள் நல்வாழ்வுத் துறை கொண்டு வந்துள்ள தேசிய கிராமப்புற சுகாதார இயக்கம் தான். இந்த திட்டத்தின் மூலம் அனைத்து மாநிலங்களும் டாக்டர்களை தற்காலிக அடிப்படையிலும்இ ஒப்பந்த அடிப்படையிலும்இ கட்டாய அடிப்படையிலும்இ பணி அமர்த்திக் கொள்ளவேண்டுமென நிர்பந்தப்படுத்துகிறது மத்திய மக்கள் நல்வாழ்வுத் துறை. இதற்கு வசதியாக ஒவ்வொரு மாநிலத்திலும் பயனாளிகள் நலச்சங்கங்கள் ஆரம்பிக்கப்பட்டுள்ளது. இதற்காக புரிந்துணர்வு ஒப்பந்தமும் கையெழுத்திடப்பட்டுள்ளது. எனவேஇ தனது தேசிய கிராமப்புற சுகாதார இயக்கம் மூலமாக மாநில அரசுகளை கட்டாய சேவையை நடைமுறைப்படுத்த வற்புறுத்திவிட்டு மாநில அரசுகளை உதாரணம் காண்பிப்பது மோசடித்தனமாகும். அதுவும் கேரளா போன்ற மாநிலங்களை உதாரணமாக காட்டுவது உள்நோக்கம் கொண்டது.

ஒரு மாநில அரசு கட்டாய சேவை திட்டத்தை கொண்டு வருவதற்கும் மத்திய அரசு கொண்டு வருவதற்கும் வேறுபாடு உள்ளது. பொது சுகாதாரம் மாநிலப் பட்டியிலில் உள்ளது. இது மாநில அரசின் உரிமைச் சார்ந்தது. தனது மாநிலத்திற்கு கட்டாய சேவை தேவையில்லை எனில் அதை ரத்து செய்து கொள்ள முடியும். எல்லா மாநிலங்களும் இதை நிறைவேற்ற வேண்டிய அவசியமும் இல்லை. ஆனால் தற்பொழுது மத்திய அரசு கொண்டு வரும் திட்டத்தின் மூலம் மருத்துவ படிப்பு காலமே 6½ ஆண்டுகளாக உயர்த்தப்படுவதால் எல்லா மாநிலங்களுமே இதை நடைமுறைப்படுத்த வேண்டும். இதனால் ஏழை - எளிய மாணவர்களும்இ தாழ்த்தப்பட்டஇ பிற்படுத்தப்பட்ட மாணவர்களும்இ பெண்களும் மிகவும் பாதிக்கப்படுவார்கள். இது தான் சமூக நீதியா?

தற்பொழுது மத்திய அரசு கொண்டு வர உள்ள கட்டாய சேவை திட்டத்தை எல்லா மாநில மருத்துவ மாணவர்களும் ஏற்றுக் கொண்டுவிட்டதாகவும் தமிழகத்தில் மட்டும் ஒரு சிறு பகுதியினர் எதிர்ப்;பதாகவும் கூறுவது தவறானதாகும். எல்லா மாநிலங்களைச் சேர்ந்த மருத்துவ மாணவர்களும் இதை எதிர்க்கின்றனர். சென்ற வாரம் கட்டாய சேவை திட்டத்தை எதிர்;த்து மகாராஷ்டிரா மாநிலத்தைச் சேர்ந்த டாக்டர்களும்இ மருத்துவ மாணவர்களும் ஒரு நாள் அடையாள வேலை நிறுத்தம் மேற்கொண்டனர். 21-11-2007 அன்று மகாராஷ்டிராவிற்கு டாக்டர் சாம்பசிவராவ் தலைமையிலான குழு வருகை தந்த பொழுது 42 மருத்துவக் கல்லூரிகளைச் சேர்ந்த மாணவர்கள் ஒட்டுமொத்தமாக அத்திட்டத்தை எதிர்த்து மனு அளித்துள்ளனர். அடுத்த கட்டமாக உண்ணாவிரத போராட்டம் நடத்தப்படும் என்றும் நேற்று அறிவித்துள்ளனர். டெல்லியில் உள்ள மருத்துவக் கல்லூரிகளைச் சேர்ந்த மாணவர்களும் போராட தயாராகி வருகின்றனர். நவம்பர் 27 வரை பல்வேறு மாநிலங்களில் தேர்வுகள் நடைபெறுகின்றன. தேர்வு முடிந்த பிறகு அம்மாணவர்களும் போராட்ட களத்தில் இறங்குவர். எனவே உண்மைக்கு புறம்பாக பா.ம.க. தகவல்களை வெளியிடுவது சரியல்ல.

மேலும் பா.ம.க வாதப்படி தமிழகத்தில் மட்டுமே போராட்டம் நடந்தாலும் அதில் என்ன தவறு உள்ளது? மத்திய உயர்கல்வி நிறுவனங்களில் 27 விழுக்காடு இடஒதுக்கீட்டை இதர பிற்படுத்தப்பட்டோருக்கு வழங்க வேண்டும் என்ற பிரச்சனை எழுந்தபொழுது தமிழகத்தில் மட்டும் தான் மருத்துவ மாணவர்கள் அதிக அளவில் போராடினார்கள். அதற்காக 27 விழுக்காடு இடஒதுக்கீடு கோரிக்கை தவறானதா? அதைக் கைவிட்டுவிடலாமா? பா.ம.க. பதில் சொல்ல வேண்டும்.

கட்டாய கிராமப்புற சேவை என்ற பெயரில் 4 மாதங்கள் மட்டுமே மருத்துவ மாணவர்கள் கிராமப்புற ஆரம்ப சுகாதார நிலையங்களில் சேவை செய்வார்கள். மீதி உள்ள 8 மாதங்களில் நகர்புறங்களில் உள்ள மாவட்ட மருத்துவமனைகளில் 4 மாதங்களும்இ தாலுகா மருத்துவமனைகளில் 4 மாதங்களும் சேவை செய்வார்கள். 8 மாதங்கள் நகர்புற மருத்துவமனைகளில் சேவை செய்யும்பொழுது இது எப்படி கிராமப்புற சேவையாகும்? எனவேஇ கிராமபுறம் என்ற கவர்ச்சிகரமான சொல்லை பயன்படுத்தி மோசடி செய்யக்கூடாது. தாலுக்கா மற்றும் மாவட்ட மருத்துவமனைகளில் டாக்டர்கள் பணியாற்ற தயங்கமாட்டார்கள். எனவே அம்மருத்துவமனைகளிலும் கட்டாய சேவையை புகுத்துவது ஏன்? 31 ஆயிரத்திற்கும் மேற்பட்ட இளம் மருத்துவர்களை கொண்டு நிரந்தரப் பணியிடங்களை ஒழித்துகட்டுவது தானே இதன் நோக்கம்? இல்லை என்று மறுக்க முடியுமா? கட்டாய சேவையில் ஈடுபடும் டாக்டர்களுக்கு ரூ.8 ஆயிரம் வழங்குவதாக கூறுவது தான் தகுந்த ஊதியமா? இது உழைப்பு சுரண்டல் அல்லவா?

தமிழ்நாடுஇ மகாராஷ்டிரம் போன்ற மாநிலங்களில் அரசு பணிக்கு டாக்டர்கள்யிடையே கடும் போட்டி நிலவுகிறது. இந்தியா முழுவதும் நிரந்தப் பணி வழங்கக் கோரி டாக்டர்கள் போராடி வருகிறார்கள். பா.ம.க புள்ளி விவரப்படி 15500க்கும் மேற்பட்ட டாக்டர்கள் வேலை வாய்ப்பின்றி இருக்கும்பொழுது அவர்களுக்கு நிரந்தர வேலைவாய்ப்பு வழங்காமல் ஏன் இந்த கட்டாய சேவையை திணிக்க வேண்டும்?

கிராமப்புறத்தில் பணி புரியும் டாக்டர்களுக்கு கூடுதல் ஊதியம்இ ஊக்க தொகைஇ முதுநிலை மருத்துவக் கல்வியில் தனி இடஒதுக்கீடுஇ கூடுதல் மதிப்பெண்இ பதவி உயர்வில் முன்னுரிமைஇ போக்குவரத்து வசதிஇ வீட்டு வசதி முதலியவை வழங்கிட வேண்டும். இதை நடைமுறைப்படுத்த மத்திய அரசு முயற்சிக்காமல் கட்டாய கிராமப்புற சேவையை திணிப்பது ஏன்?

சுயமாக சிந்தித்து திட்டத்தை நடைமுறைப்படுத்த முடியாத மத்திய மக்கள் நல்வாழ்வுத் துறை உலக வங்கியின் திட்டத்தை நடைமுறைப்படுத்துவேன் என பிடிவாதம் பிடிக்கிறது. இந்நிலையில் சுயமாக போராடும் மருத்துவ மாணவர்களின் போராட்டத்தை தூண்டிவிட்டு நடைபெறும் போராட்டம் என்பது நகைப்புக்குரியது.

எனவேஇ இத்திட்டத்தை கைவிட்டுவிட்டு சமூக நீதியையும்இ இளம் டாக்டர்களின் வேலை வாய்ப்பை பாதுகாக்க முன் வர வேண்டும். அரசு மருத்துவமனைகளுக்கு வருகை தரும் நோயாளிகளிடம் தேசிய கிராமப்புற சுகாதார இயக்கத்தின் மூலம் சிகிச்சைகளுக்கும்இ பரிசோதனைகளுக்கும் கட்டாய கட்டணம் வசூல் செய்வதை கைவிட வேண்டும்.

S.NO. 119825/1 &0/CON.97. -Dated : 27.05.97


Instructions were issued in Chief office Memo vide (C.N.) 8523/1 & O Confd 1/91) dated 6.4.91 that when complaints of cognizable offences are received against Medical Practitioners relating to criminal negligence in the course of Medical treatment arrests need not be resorted to as a matter of course. It was also emphasized in the memo that when the Medical practitioner is involved in such police complaint the fact should be brought to the notice of higher supervisory Officers who will keep a close watch on the progress of the case to ensure that there is no vindictive or vexations action.

2. Inspite of these specific instructions an instance has come to notice where in a similar complaints of negligence on the part of a Medical Practitioners arrests have been made resulting in avoidable criticism against the Police. It is once again reiterated that in such cases arrests should not be resorted to as a matter of course. The cases will be duly investigated and any action should be fully supported by a documentary evidence, supervisory approval strengthened with the opinion of the Law office.

3. These instructions will be followed in future.

4. Please acknowledge the receipt.

GO No 271-2006-H &FW Dept dt 21-12-2006 Rural Posting

Download the PIP of NRHM (National Rural Health Mission) here

Chennai (PTI): The Centre will launch a National Organ Transplant Programme in three to four months to make organ transplants more transparent and to create more awareness about them, Union Health Minister Anbumani Ramadoss said on Saturday.

Speaking to reporters here, Ramadoss said organ transplant centres would be set up at ten places, including the four metropolitan cities, with central grants. Online registration of transplants would be made compulsory, he said.

The need for organs was very high and donation of organs of brain-dead persons would be encouraged by providing 'prizes', 'awards' and free railway passes to the kin, he said without elaborating.

The Centre will introduce an amendment to the Organ Transplant Act to make punishment for illegal transplants more stringent.

On compulsory rural service for medical students, he said Dr Sambasivam committee had been constituted to look into the objections and to elicit the opinions of students, doctors and people. The Centre would take further action on the issue after the committee submitted its recommendations, he said.

He alleged that some people were inciting students against rural service for their selfish gains. Students should be service-minded and they should make use of their valuable experience for the betterment of rural folk, he said.

The government has modernised rural health infrastructure, but it still lacked sufficient number of doctors as they were not willing to serve in rural areas, he said.

The government was only collecting about Rs 4000 as annual fees from the Government Medical College students, while rest of the amount came from public money, whereas private medical students were paying about Rs four to five lakh, he said.

Tamil Nadu occupied the numero uno position in health services and the co-existence of Indian and modern medical system was one of the reasons behind this feat, he added.

Earlier, he inaugurated an inter-disciplinary seminar for medical professionals on "Detection and management of child abuse".

VIJAYAWADA: Working for a minimum of five years in rural areas would be made mandatory for all doctors who complete the undergraduate course in future, according to Minister for Vaidya Vidhana Parishad and Hospital Services Vanama Venkateswara Rao.
The Minister made a surprise check of a couple of wholesale drug establishments in One Town and a blood bank in Governorpet on Tuesday.
Talking to reporters later, Mr. Venkateswara Rao said the healthcare sector was badly neglected by the earlier Government.
He said the Government would soon issue a notification for the recruitment of 700 staff nurses.
Notifications had already been issued for the recruitment of 534 specialist doctors, 135 dentists and 450 paramedical staff.
The process of recruitment would be completed by November-end.

Trauma care centres

The Government had earmarked an additional 40 per cent of the budget for healthcare to provide emergency treatment for poor patients.
The Government had earmarked Rs. 5,000 crores for providing healthcare to the poor under a health scheme. The Government had also released Rs. 72 crores for establishing ten trauma care centres along the national highways.
The Minister warned of stringent action against the manufacturers and distributors of substandard or spurious
He said the minimum sentence for dealing with spurious drugs was three years. Manufacturers and distributors caught dealing with spurious drugs would be blacklisted permanently, the Minister said.

Source: The Hindu ( http://www.hinduonnet.com/2007/10/17/stories/2007101761350500.htm )

Publication: Bulletin of the World Health Organization; Type: Research
Article ID: 07-041681; Article DOI: 10.2471/BLT.07.048681
Manas Kaushik et al.
High-end physician migration from India
High-end physician migration from India
Manas Kaushik,a Abhishek Jaiswal,b Naseem Shahb & Ajay Mahalc
a Departments of Nutrition and Epidemiology, Harvard School of Public Health, 677 Huntington Ave, Boston
02115 MA, United States of America. Correspondence to Manas Kaushik (e-mail:
mkaushik@hsph.harvard.edu).
b All India Institute of Medical Sciences, New Delhi, India.
c Department of Population and International Health, Harvard School of Public Health, Boston, MA, USA.
Bulletin of the World Health Organization 2007;85:XXX–XXX
Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una
traducción al español. ة ل 􀑧􀑧􀑧 ة العربي 􀑧􀑧􀑧 ي ن ەذەالترجم 􀑧􀑧􀑧 ة ف 􀑧􀑧􀑧 صەالخلاص 􀑧􀑧 ة الن 􀑧􀑧 ل ل اي 􀑧􀑧 ة ەذەالكام 􀑧􀑧􀑧 .المقال
doi: 10.2471/BLT.07.041681
(Submitted: 23 February 2007 – Revised version received: 11 June 2007 – Accepted: 25 June 2007)
Objective To examine the relation between the quality of physicians and migration among
alumni of All India Institute of Medical Sciences (AIIMS), New Delhi, India over the period
1989–2000.
Methods In a retrospective cohort study, data on graduates of AIIMS were collected from
entrance exam qualifier lists, the AIIMS alumni directory, convocation records, the American
Medical Association and informal alumni networks. The data were analysed by use of 2x2
contingency tables and logistic regression models.
Findings Nearly 54% of AIIMS graduates during 1989–2000 now reside outside India.
Students admitted under the general category are twice as likely to reside abroad (95% confidence interval: 1.53–2.99) as students admitted under the affirmative-action category.
Recipients of multiple academic awards were 35% more likely to emigrate than non-recipients
of awards (95% confidence interval: 1.04–1.76). Multivariate analyses do not change these
basic conclusions.
Conclusion Graduates from higher quality institutions account for a disproportionately large
share of emigrating physicians. Even within high-end institutions, such as AIIMS, better
physicians are more likely to emigrate. Interventions should focus on the highly trained
individuals in the top institutions that contribute disproportionately to the loss of human
resources for health. Our findings suggest that affirmative-action programmes may have an unintended benefit in that they may help retain a subset of such personnel.
Introduction
The migration of skilled professionals from developing to developed countries has long attracted
attention from researchers and policy-makers.1,2 The literature on the subject encompasses a vast area, including assessments of the implications of skilled labour migration for equity and efficiency in economic outcomes, examinations of the links between growth in international trade and trends in international migration, and optimum strategies to address losses to sending countries due to
Page 1 of 12
Publication: Bulletin of the World Health Organization; Type: Research
Article ID: 07-041681; Article DOI: 10.2471/BLT.07.048681
emigration.3,4 Migration of medical professionals has attracted concern in light of their impact on
health policy goals.5–7 In a seminal 2004 report, the Joint Learning Initiative (JLI) devoted an entire
chapter to international flows of doctors and nurses, and their potentially harmful effects on the less
well off in developing countries. As the report points out, “while the absolute numbers may not be very
large, the outflows can be ‘fatal’ for disadvantaged people in source countries”.8 The world health
report: working together for health, also reached a similar conclusion.9
Considerable information exists on the “push and pull” factors operating in different countries
and the number of doctors migrating from India to other countries, particularly towards Europe and the
United States of America.10,11 However, much less is known about the quality of medical professionals
who migrate, compared with those who remain. The issue of the quality of professionals emigrating is
important both for destination countries where these physicians eventually practice,12,13 but also for
source countries. While the number of physicians emigrating is one dimension of the human capital
involved in migration,14 simple head counts are insufficient if the individuals who emigrate are
academic leaders or better-skilled physicians than those who remain. This set may include institution
builders who are trainers, professors in medical schools, or physician leaders who influence positively,
by example or collaboration, the quality of health services provided by others who remain in the
country. By adversely affecting the training, leadership, and possibly even managerial capacity, the
emigration of high-quality medical professionals adversely affects the health system in a way that
cannot be captured in statistics on the numbers of migrants among medical professionals.
Among developing countries, India is the biggest exporter of trained physicians with Indiatrained
physicians accounting for about 4.9% of American physicians and 10.9% of British
physicians.10 We assess the relation between physician quality and emigration with information on
graduates of the All India Institute of Medical Sciences (AIIMS), India’s top ranked medical school,
over the period 1989–2000. Because there are no readily available objective measures for assessing the
long-term academic or leadership potential of newly trained physicians, we used several indicators of
quality. First, we compared overall emigration rates among AIIMS graduates to those for medical
schools in India as a whole, on the assumption that acceptance into an exclusive institution on the basis
of their performance in medical admission tests is an indicator of both greater academic preparedness
for medical school and overall ability.15 Related to this point, we also inquired whether students
admitted under an affirmative-action quota, whose scores in the AIIMS entrance examination were
generally lower than those of other entrants, have a lower likelihood of emigrating. Finally, we
Page 2 of 12
Publication: Bulletin of the World Health Organization; Type: Research
Article ID: 07-041681; Article DOI: 10.2471/BLT.07.048681
considered whether individuals who received academic awards at the time of graduation from AIIMS
were more likely to emigrate.
Methods
AIIMS admits students through an objective exam, in which 45 students from a typical pool of 30 000
applicants (0.15%) are selected. We assembled a cohort of AIIMS graduates who entered AIIMS from
1989 through2000, and extracted information on their state of residence at the time of entry and
whether admission was made under the affirmative-action programme from entrance-exam
notifications and national newspapers where exam results are published.
We identified the country of residence, gender and year of graduation for AIIMS graduates
from published16 and online alumni directories,17 with follow-up contacts with individual graduates and
their classmates for whom information was not accessible in these directories. We ensured consistency
of this information with physician registration data in the United States of America, where many
AIIMS graduates migrate. With the exception of two inconsistencies (which we addressed), our
information on country of residence, gender and year of graduation matched exactly with information
on residence available from the American Medical Association data set. However, the American
Medical Association data set does not include information on physicians who are currently enrolled in
graduate programmes (e.g. masters and doctoral courses) and research positions, for instance, and
constitute an important avenue for migration of new graduates. Moreover, there is a lag of 1–2 years in
updating American Medical Association data sets even after physicians join residency programmes.
Thus, we believe that our data set is more up to date than the American Medical Association database.
Information on academic awards received by AIIMS graduates for the years 1989–2000 was collected
from convocation booklets (graduation records) published annually by the institution.
At least 11 of the 45 students are admitted to AIIMS each year under a distinct admission track
for two population subgroups: scheduled castes and scheduled tribes that are considered particularly
deprived under the Indian Constitution. Some 800 castes (of a total of 3000 in India) are categorized as
belonging to scheduled castes, with another 250 groups designated as scheduled tribes.18 The defining
criterion for these groups includes economic and social deprivation, more fully described in an Indian
government commission report.19 Students from these groups whose scores exceed this minimum
become part of the general pool, irrespective of their social background. While we were unable to
obtain admission scores for the entire group 1989–2000, we were able to do so for a group of 394 new
students from 1998 through 2006. Our data show that the affirmative-action group had a mean score of
Page 3 of 12
Publication: Bulletin of the World Health Organization; Type: Research
Article ID: 07-041681; Article DOI: 10.2471/BLT.07.048681
56.5 (standard deviation = 4.5), whereas the general group (excluding affirmative-action candidates)
had a mean score of 69.4 (standard deviation = 3.8), out of a maximum of 100. Thus, we used
admission under affirmative-action category as a proxy for lower academic preparedness and ultimately
lower quality.
The use of entrance examination marks, or admission under the quota, as an indicator of quality
is problematic as entrance examination scores might not truly reflect ability among socially
disadvantaged people and the decision to emigrate might be based on social networks and economic
ability that can vary across different admission categories. We also used the receipt of academic awards
as a distinct proxy for quality, and compared emigration rates among award recipients and nonrecipients.
In general, because physicians practicing at AIIMS and other public institutions are shielded
from medical malpractice suits by virtue of working in the public sector,19 malpractice suits are
probably not a good indicator of quality, since some AIIMS graduates end up at public institutions.
Furthermore, the onerous nature of the Indian legal system discourages such suits.20 The use of clinicalvignette-
based standardized examination, such as United States Medical Licensing exams, in assessing
physicians, even for residency positions, is discouraged. In the absence of available and accepted
indicators of physician quality, particularly of international medical graduates, most of whom emigrate
soon after graduation, we believe that academic achievement can be used as an indicator of quality.21
We compared emigration rates among groups for alternative indicators of quality, using
proportions and multivariate logistic models for assessing the relative likelihood of migrating. Because
some individuals might have better access to, desire for, and information about opportunities for
migration, confounding might occur. If this propensity to migrate is randomly distributed across
individuals, our results will be unaffected. However, if this propensity were positively correlated with
academic performance,4 it would bias the magnitude of the relationship between emigration and
graduate quality upwards. Other elements of heterogeneity (patriotism or closer family ties) may bias
the relationship in the opposite direction. We sought to partly address such concerns by using
information on the region of origin of AIIMS graduates and their gender in a multivariate regression
analysis to potentially control for such biases.
A total of 564 students graduated from AIIMS during 1989–2000. We could not obtain
information on either the affirmative-action status or province of origin for 136 graduates. This left us
with a sample of 428 individuals. Of this, 21.2% belonged to the affirmative-action category, very
Page 4 of 12
Publication: Bulletin of the World Health Organization; Type: Research
Article ID: 07-041681; Article DOI: 10.2471/BLT.07.048681
close to the proportion admitted under affirmative action (22.5%). We used this sample to assess the
proportion of graduates emigrating by gender, region of origin, and affirmative-action category
(Table 1) and used multivariate logistic regression to assess the likelihood of emigration (Table 2). The
dependent variable in all of the four regression specifications in Table 2 took the value 1 if the
individual resided abroad and was 0 otherwise. For explanatory variables in multivariate regressions,
we included sex, time since graduation, the square of time since graduation and indicator variables for
region of origin in all models. The main difference in the four regression models used in this paper is
the indicator of quality used: an indicator variable indicating whether admission was under the
affirmative-action category or not (model 1), the logarithm of entrance exam scores for students for the
years they were available (1998–2000; model 2), an indicator variable for any award received
(model 3), and indicators, respectively, for exactly one award and for receiving more than one award
(model 4).
Because the information we possess is on the current residence of physicians, some individuals
in our sample might have returned after a stay abroad, whereas others may have moved both back and
forth. If so, the correct interpretation of dependent variable is that it reflects the cumulative probability
of net emigration of graduates. In fact, the number of returning migrant doctors from AIIMS appears to
be miniscule. For AIIMS graduates during the years 1996–2000, for which we have more detailed
information, only one of the emigrating AIIMS graduates returned to India and that was for just 1 year.
Results
Nearly 54% of AIIMS students who graduated during 1989–2000 now reside outside India. Of the total
alumni emigrating in this group, 85.4% emigrated to the United States of America with no significant
gender differences in the proportion emigrating. This conclusion is in line with our preliminary
examination of AIIMS alumni records showing that roughly 730 out of a total of 1440 AIIMS
graduates, dating all the way back to the early 1960s, reside abroad, suggesting emigration of at least
51%. Of the 428 students in our sample, 52 received at least one award, with some receiving more than
one, amounting to a total of 116 awards. Only one student of 87 (or 1.2%) in the affirmative-action
category received an academic award at the time of graduation, compared to 15.2% in the general
category, supporting the argument that this category may reflect a lower level of academic skill.
Table 1 presents cumulative emigration rates of AIIMS students graduating during 1989–2000
by gender, admission and award category. Among graduates over this period, we find that students
from the general group are nearly two-times more likely to be residing abroad (95% confidence
Page 5 of 12
Publication: Bulletin of the World Health Organization; Type: Research
Article ID: 07-041681; Article DOI: 10.2471/BLT.07.048681
interval: 1.53–2.99, P < p =" 0.436).">1. Grubel H, Scott A. The brain drain: determinants, measurement and welfare effects.
Waterloo, ON: Wilfrid Laurier University Press; 1977.
2. Bhagwati J, Wilson J. Income taxation and international mobility. Cambridge, MA:
MIT Press; 1989.
3. Bhagwati J, Hamada K. The brain drain, international integration of markets for
professionals and unemployment. J Dev Econ 1974;1:19-42.
4. Stark O. Rethinking the brain-drain. World Dev 2004;32:15-22.
5. Mullan F. Doctors for the world: Indian physician emigration. Health Aff 2006;25:380-
93.
Page 8 of 12
Publication: Bulletin of the World Health Organization; Type: Research
Article ID: 07-041681; Article DOI: 10.2471/BLT.07.048681
6. Vujicic M, Zurn P, Diallo K, Adams O, Dal Poz MR The role of wages in the migration
of health care professionals from developing countries. Hum Resour Health
2004;2:3
7. Chanda R. Trade in health services. Bull World Health Organ 2002;80:158-63.
8. Joint Learning Initiative (JLI). Human resources for health: overcoming the crisis.
Cambridge,MA: Harvard University Press; 2004.
9. The world health report 2006: working together for health. Geneva: WHO;
2006.
10. Mullan F. The metrics of the physician brain drain. N Engl J Med 2005;353:1810-
8.
11. Astor A, Akhtar T, Matallana M, Muthuswamy V, Olowu F, Tallo V, et al. Physician
migration: Views from professionals in Colombia, Nigeria, India, Pakistan and the
Philippines. Soc Sci Med 2005; 12(61):2492-500.
12. Salsberg E, Grover A. Physician workforce shortages: implications and issues for
academic health centers and policymakers. Acad Med 2006;81:782-7.
13. Kindig DA, Libby DL. Domestic production vs international immigration: Options for
the US physician workforce. JAMA 1996;276:978-82.
14. Grubel H, Scott A. The international flow of human capital. Am Econ Rev
1966;56:268-74.
15. Julian ER. Validity of the medical college admission test for predicting medical
school performance. Acad Med 2005;80(10):910-7.
16. Bhatnagar V, Sahni P, Agarwala S, Sahni P, Agarwala S. The Aiimsonian directory.
New Delhi, India: The Aiimsonians; 2003.
17. Government of India. The Constitution of India. New Delhi, India: Law Ministry;
1996.
18. aiims-usa.com [Home page on the internet]. Newton, MA: Aiimsonians of America,
Inc.; c. 1999-2002. Available at: http://aiims-usa.com/
19. Pande R. Can mandated political representation increase policy influence for
disadvantaged minorities? Theory and evidence from India. New York: Columbia
University, Department of Economics; 2000.
20. Bhat R. Regulating the private health care sector: the case of the Indian Consumer
Protection Act. Health Policy Plan 1996;11:265-79.
21. Das J, Hammer J. Money for nothing: the dire straits of medical practice in Delhi,
India [World Bank Policy Research Working Paper]. Washington, DC: The World Bank;
2005.
22. Dambisya YM. The fate and career destinations of doctors who qualified at Uganda's
Makerere Medical School in 1984: retrospective cohort study. BMJ 2004;329:600-
1.
23. Ihekweazu C, Anya I, Anosike E. Nigerian medical graduates: where are they now?
BMJ 2005;365:1847.
Page 9 of 12
Publication: Bulletin of the World Health Organization; Type: Research
Article ID: 07-041681; Article DOI: 10.2471/BLT.07.048681
24. Bhatt RV, Soni JM, Patel NF, Doctor PS. Migration of Baroda medical graduates,
1949–72. Med Educ 1976;10:290-2.
25. Hagopian A, Thompson MJ, Fordyce M, Johnson KE, Hart LG. The migration of
physicians from sub-Saharan Africa to the United States of America: measures of the
African brain drain. Hum Resour Health 2004;2:17.
26. Rosselli D, Otero A, Maza G. Colombian physician brain drain. Med Educ
2001;35:809-10.
27. Akl EA, Maroun N, Major S, Chahoud B, Schunemann HJ. Graduates of Lebanese
medical schools in the United States: an observational study of international migration
of physicians. BMC Health Serv Res 2007;7:49.
Page 10 of 12
Publication: Bulletin of the World Health Organization; Type: Research
Article ID: 07-041681; Article DOI: 10.2471/BLT.07.048681
Table 1. Demographic, award and emigration information on AIIMS graduates, 1989–2000
Characteristic Category Total Emigrated
% (n)
P-valuea
(2-sided)
Gender Men 350 54.9 (192) 0.436
Women 78 50.0 (39) –
Region 1b 101 61.4 (62) 0.090
2c 30 63.3 (19) –
3d 132 46.2 (61) –
4e 165 53.9 (89) –
Affirmative action 87 28.7 (25) < 0.0001
No awards 375 53.6 (201) 0.096
One award 28 42.9 (12) –
Two or more awards 25 76.5 (18) –
a P-values based on χ2 test and assess whether the proportion of students migrating differs across groups.
b Region 1: Punjab, Haryana, Himachal Pradesh, Chandigarh.
c Region 2: Maharashtra, Andhra Pradesh.
d Region 3: Bihar, Madhya Pradesh, Uttar Pradesh, Rajasthan.
e Region 4: Karnataka, Tamil Nadu, Kerala, North Eastern States, Jammu & Kashmir, West Bengal, Delhi.
Table 2. Quality and emigration among AIIMS graduates 1989–2000: logistic regression
results
Dependent variable: indicator of emigration
(standard error of the logistic regression estimates)
Explanatory variable
model 1 model 2 model 3 model 4
N 428 113 428 428
Constant 0.06
(0.35)
−30.80a
(10.81)
−0.37
(0.34)
−0.40
(0.35)
Sex
(male = 1, 0 otherwise)
0.08
(0.27)
−0.71
(0.53)
0.15
(0.26)
0.16
(0.26)
Time (since graduation) 0.24a
(0.11)
−1.91b
(1.02)
0.25a
(0.11)
0.25a
(0.11)
Time squared −0.02a
(0.01)
0.87b
(0.48)
−0.02a
(0.01)
−0.02a
(0.01)
Affirmative action
(yes = 1, 0 otherwise)
−1.42a
(0.28)
– – –
Log (entrance marks) – 7.47a
(2.58)
– –
Indicator variable
(one or more awards)
– – 0.25
(0.30)
Indicator variable 1
(one award)
– – – −0.36
(0.41)
Page 11 of 12
Publication: Bulletin of the World Health Organization; Type: Research
Article ID: 07-041681; Article DOI: 10.2471/BLT.07.048681
Indicator variable 2
(two awards or more)
– – – 0.99a
(0.47)
Dummy for region 1c 0.20
(0.27)
0.43
(0.54)
0.35
(0.26)
0.38
(0.26)
Dummy for region 2d 0.76b
(0.45)
0.02
(1.58)
0.35
(0.42)
0.43
(0.42)
Dummy for region 3e −0.25
(0.25)
−0.28
(0.53)
−0.26
(0.24)
−0.24
(0.24)
χ2 43.21 15.41 14.68 20.03
AIIMS, All India Institute of Medical Sciences.
a P < 0.05; P-values based on logistic regression (Wald test).
b P < 0.10; P-values based on logistic regression (Wald test).
c Region 1: Punjab, Haryana, Himachal Pradesh, Chandigarh.
d Region 2: Maharashtra, Andhra Pradesh.
e Region 3: Bihar, Madhya Pradesh, Uttar Pradesh, Rajasthan.
Page 12 of 12

by

Dr. Umesh Kapil, Professor, AIIMS

7. Diphtheria, measles on a killing spree. The Times of India, New Delhi, 2004; pp 12.